Financial burden among liver transplant candidates is associated with financial distress and work impairment: A U.S. multicenter study

BACKGROUND: The financial impact of chronic liver disease among adults undergoing liver transplant (LT) evaluation remains understudied. We performed a cross-sectional multicenter study to explore high financial burden, defined as medical out-of-pocket expenses ≥10% of income (per prior literature), among adult LT candidates. We aimed to identify associations between high financial burden and (1) work productivity impairment; (2) financial distress (material, behavioral, and psychological consequences of financial burden); (3) financial toxicity (health-related quality of life, HRQOL). METHODS: From May 2023 to April 2024, 453 patients from 13 United States transplant centers were included. Patients completed questionnaires assessing financial burden, financial distress, financial toxicity (EuroQol EQ-5D-5L instrument), and work productivity and impairment (Work Productivity and Activity Impairment Questionnaire: Specific Health Problem Version). RESULTS: Among LT candidates, 23.3% reported a high financial burden, and only 27.6% were employed. High financial burden was associated with a higher rate of absenteeism from work (34.1% vs. 16.9%, p=0.018) among employed participants. In adjusted models, high financial burden was significantly associated with inability to pay for basic necessities (aOR 4.76, 95% CI: 2.34-9.67), delayed or foregone medical care (aOR 4.02, 95% CI: 2.30-7.02), and psychological distress (aOR 4.63, 95% CI: 1.95-10.98) but was not associated with HRQOL (EQ-5D β: -0.04, 95% CI: -0.08 to 0.00; EQ-5D-VAS β: -4.53, 95% CI: -10.1 to 1.02). CONCLUSION: These results highlight the critical importance of implementing routine screening for financial burden in this high-risk population and developing strategies to mitigate associated adverse outcomes.

Authors

Institutions

Publication Details

Journal
Hepatology Communications
Published
2026-06-29
DOI
https://doi.org/10.1097/hc9.0000000000000985
Primary Topic
Economic and Financial Impacts of Cancer
Type
article
Field-Weighted Citation Impact
0.00
Controls
|||
ALL TIME
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
article

Financial burden among liver transplant candidates is associated with financial distress and work impairment: A U.S. multicenter study

Nneka N. Ufere, Deepika Devuni, Anushka Dalvi, Brett E. Fortune et al.
Hepatology Communications
Economic and Financial Impacts of Cancer
article

Financial burden among liver transplant candidates is associated with financial distress and work impairment: A U.S. multicenter study

Nneka N. Ufere, Deepika Devuni, Anushka Dalvi, Brett E. Fortune, Sarah R. Lieber, Stela Celaj, Areej Mazhar, Elizabeth S. Aby, Dempsey Hughes, Alan Noll, Patricia Jones, Lina Nurhussien, Alvaro Noriega Ramirez, Lucinda Li, Chengbo Zeng, Thomas M. Leventhal, Kali Zhou, Hersh Shroff, Nathaly Cortez Bazan, Krista Hunt, Shari Rogal, Grace Bizup, Lauren Nephew, Clara Tow, Paola Mejia, Nora Horick, Enya Zhu, Mike Kriss, Melanie Hundt, Lindsay Y. King, Malia Armstrong, Jackie B. Henson, Anita Krisharao, Jonathan Rice
article en

Abstract

BACKGROUND: The financial impact of chronic liver disease among adults undergoing liver transplant (LT) evaluation remains understudied. We performed a cross-sectional multicenter study to explore high financial burden, defined as medical out-of-pocket expenses ≥10% of income (per prior literature), among adult LT candidates. We aimed to identify associations between high financial burden and (1) work productivity impairment; (2) financial distress (material, behavioral, and psychological consequences of financial burden); (3) financial toxicity (health-related quality of life, HRQOL). METHODS: From May 2023 to April 2024, 453 patients from 13 United States transplant centers were included. Patients completed questionnaires assessing financial burden, financial distress, financial toxicity (EuroQol EQ-5D-5L instrument), and work productivity and impairment (Work Productivity and Activity Impairment Questionnaire: Specific Health Problem Version). RESULTS: Among LT candidates, 23.3% reported a high financial burden, and only 27.6% were employed. High financial burden was associated with a higher rate of absenteeism from work (34.1% vs. 16.9%, p=0.018) among employed participants. In adjusted models, high financial burden was significantly associated with inability to pay for basic necessities (aOR 4.76, 95% CI: 2.34-9.67), delayed or foregone medical care (aOR 4.02, 95% CI: 2.30-7.02), and psychological distress (aOR 4.63, 95% CI: 1.95-10.98) but was not associated with HRQOL (EQ-5D β: -0.04, 95% CI: -0.08 to 0.00; EQ-5D-VAS β: -4.53, 95% CI: -10.1 to 1.02). CONCLUSION: These results highlight the critical importance of implementing routine screening for financial burden in this high-risk population and developing strategies to mitigate associated adverse outcomes.

Hepatology CommunicationsVol. 10(7)
Northwestern University (US), University of North Carolina at Chapel Hill (US), University of Southern California (US), Brigham and Women's Hospital (US), Albert Einstein College of Medicine (US), University of Minnesota (US), University of Miami (US), University of Massachusetts Chan Medical School (US), Jackson Memorial Hospital (US), Massachusetts General Hospital (US), Memorial Health System (US), University of Pittsburgh Medical Center (US), Duke University Health System (US), UMass Memorial Medical Center (US), Indiana University – Purdue University Indianapolis (US), The University of Texas Southwestern Medical Center (US), University of Colorado Denver (US)
Openalex Percentile: Top 3%
Economic and Financial Impacts of Cancer
DOIOpen Access PDFOpenAlex
AI Navigator

Ask Laika to Summarize, Analyze, and Connect papers live on the map.

Summarize Papers & Methodologies

Extract key findings, datasets, and comparative methods across publications.

Benchmark Rankings & Visual Analytics

Rank top research institutions, authors, funders, topics, and journals by Field-Weighted Citation Impact (FWCI) and paper volume with instant charts.

Connect Distant Disciplines

Bridge topological clusters on the map to find hidden collaborative intersections.